Neurobiological Underpinnings of Bonding Analysis

Table of Contents

The Origins of Bonding Analysis

Prenatal Bonding

Prenatal Bonding: Its Importance, Functioning, and Neurobiological Processes

The Impact of Maternal Stress During Pregnancy

The Impact of Prenatal Influences: A Case History

Further Prenatal Traumas

Neurobiological Underpinnings of Bonding Analysis

References

In the late 1980s, an eminent Hungarian psychotherapist, the late Dr. Jenö Raffai, developed a revolutionary new method he later called Bonding Analysis with which he accompanied pregnant women throughout their pregnancy, enabling the mothers-to-be to get into mental and emotional contact with their unborn babies. The primary objectives were on the one hand to satisfy the baby’s primal needs for bonding—that is to say, for feeling accepted, secure, protected, and most of all loved—and on the other hand to enhance the future mother’s bonding capacity.

The Origins of Bonding Analysis

The origins of this new approach were root­ed in Dr. Raffai’s psychoanalytical treatment of a particular psychotic youth. Dr. Raffai discov­ered that the youth’s psychic disturbances could be traced back to the time he had spent in his mother’s womb. What he predominantly lacked was the conscious feeling of his physical bounda­ries, which made it impossible for him to perceive himself as an autonomous being, making him feel devoid of having a body of his own. Searching for the causes of these phenomena, Raffai found out that the youth’s mother had suffered the loss of her hus­band during the pregnancy. Instead of mourning that loss in an adequate way she had transferred this trauma to her unborn baby, considering it thenceforward to be an integral part of her own body and not wanting to let it go, so she would not lose it as she had lost her husband. At that moment the development of the baby’s self-per­ception of its physical boundaries came to a standstill.

Raffai explained that by transferring that image to her baby it stopped perceiving itself as an autonomous be­ing. The baby could no longer differentiate between its own body sensations, feelings, and cognitive processes and those of its mother. The development of an autono­mous self can only take place if the baby perceives its own self on the basis of the image that has developed in the mother’s consciousness; this is imperative for allow­ing the unfolding of fetal self-awareness (Raffai & Hidas, 2010).

Prenatal Bonding

To be mirrored necessitates the existence of another person, which form the basis of a relationship. With re­gard to the prenatal and postnatal relationship between mother and child, the two appropriate terms are bond­ing (on the mother’s side) and attachment (on the ba­by’s side). Raffai concentrated his work on developing a method of analyzing the bonding capacity of pregnant women and then worked towards strengthening it; in cases of poor bonding, he would endeavor to find the reasons for this and then make the women aware of the problem, thus empowering them to establish a healthy, stable, protective, and supportive bonding relationship with their babies long before their birth. In this way the securely attached babies were themselves being em­powered to develop a healthy self, and later, outside their mothers’ wombs, socially and emotionally stable relationships. The primary focus of Raffai’s work was the utmost importance of the emotional and mental states of pregnant women during the gestation period and their impact on the babies.

Bonding is the baby’s most essential primal need because when fulfilled it secures its survival. The infant behaves in ways that elicit contact or proximity to the caregiver—in most cases the mother. The newborn baby possesses the necessary innate instinct to use a certain behavioral repertoire, transmitted via genetic program­ming and the transfer of intergenerational experiences, to ensure that its primary caregiver provides food and conveys feelings of protection and affectionate support when catering to its needs (Hüther, 2006).

Prenatal Bonding: Its Importance, Functioning, and Neurobiological Processes

The essential questions are now, first, why is prenatal bonding more important than the bonding that starts after birth, as is still a common assumption among the public at large? Second, how does prenatal bonding work? And, last but not least, what are the neurobiologi­cal underpinnings of prenatal bonding and its impact on the developing brain?

The answer to the first question is given by Professor Gerald Hüther, a renowned German neurobiologist and brain researcher: the first bonding, which actually starts at conception, is the very first and earliest bonding ex­perience of every human being and serves as an inter­nal working model for all future relationships (Hüther, 2006). Hüther’s model is based on the expectation/ assumption that others are trustworthy, that one sees oneself as valuable, and that this self is effective when interacting with others.

Furthermore, and as essential as the first reason, prenatal bonding definitively has the greatest positive effect on the development of the fetal brain, especially the limbic system and the brain stem. The system that controls the bonding behavior is situated in the orbito­frontal cortex of the right-brain hemisphere. This region harbors the circuitry between the lower emotional areas and the higher cognitive regions—the place where cog­nitive and emotional processes are integrated and coor­dinated. It has been shown, for example, that emotional negligence and child abuse lead to a reduction in the growth of synapses within the orbitofrontal cortex. (The synapses are the linking elements within the neuronal networks; information is transported from cell to cell by neurotransmitters.) The orbitofrontal cortex represents the highest level of behavioral control and regulation of limbic excitation, including the newborn’s capacity for self-regulation (Hüther, 2012).

The prenate’s brain development starts as early as the 18th day after conception with the formation of the neural tube that will grow during the next six weeks into the main brain structures of cerebellum, thalamus, basal ganglia, and cerebral cortex. Every day, around 700 new synaptic connections are formed in the prenate’s brain, creating altogether around 60 million new neuronal networks per day. The baby is born with approximately 100 billion neurons while the adult brain consists of hun­dreds of billions of neurons connected via thousands of billions of neural synapses that determine our cognitive, emotional, and behavioral processes. The more synaps­es a human brain has the more complex and differenti­ated its neuronal networks will be.

The setting up of the highly complex interconnect­ed neuronal networks—comprising all cognitive and psychological processes linked by neuro-electrical and neuro-chemical activity—begins in the womb. Genetic information constitutes the basis for the development of the nervous system, but the neuronal connections may be influenced by negative factors such as maternal stress and alcohol or drug abuse. Neural networks can also be altered with the help of effective early bonding experiences that subsequently have a positive impact on the development of a child’s adult personality. Neu­ronal circuits are extremely plastic, which means they can easily adapt to new circumstances.

Professor Hüther (2008) explains the function of the synaptic connections in the following way. They turn into inner representations (mental pictures) that ingrain themselves into the baby’s brain. With every new image the baby expands its knowledge about the world out­side its mother’s womb so that the moment it is born it already possesses a vast amount of these mental im­ages and associative connections. This experience also helps the baby to form a positive interior maternal im­age that is not only linked to the visual cortex but is also associated with her special voice and scent and is espe­cially marked by their common experiences. The more positive internal images the mother conveys to her baby the more anchored and consolidated that kind of expe­rience becomes in the prenate’s brain (Hüther, 2008).

How does Raffai’s bonding analysis work? Com­munication between mother and baby takes place via mental pictures, visualizations, and verbal messages. Everything that is being sent and said is registered by the baby’s mind and body. This communication is made possible through mirror neurons, which form the neu­ronal basis of the human capacity for emotions such as empathy. After the first series of baby sessions the flow of information and communication becomes more and more intense and the mother develops intuition for her baby’s needs. That way the baby’s learning ability is en­hanced and its brain intensely stimulated (Balkenhol- Wright & Karrasch, 2017).

Another channel through which mother and baby communicate is via the different brainwaves— alpha, delta, and theta waves. At the root of all our thoughts, emotions, and behaviors is the communication between neurons in our brains. Brainwaves are produced by syn­chronized electrical pulses resulting from masses of neu­rons communicating with each other. Alpha brainwaves open the door to meditative states and facilitate the visualization of mental images: they aid overall mental co­ordination, calmness, and mind/body integration. Delta brainwaves are generated in deepest meditation and dreamless sleep: they suspend external awareness and are the source of empathy. Theta brainwaves are domi­nant in sleep and deep meditation: they open the gates to learning and memory. When these waves are active our senses are withdrawn from the external world and focused on signals originating from within. Vivid image­ry is enhanced, and intuition and information beyond our normal conscious awareness are being activated. This is exactly what happens when a pregnant woman is gently led into a meditative state during bonding analy­sis sessions.

The Impact of Maternal Stress During Pregnancy

In all the years Raffai accompanied pregnant women he saw that the majority of them were to a greater or lesser extent in situations of stress. How does stress af­fect the development of the prenate’s brain? If the un­born baby is flooded by its mother’s stress hormones, or if the mother’s anxiety is transferred to the baby for a long period of time, then the baby might not be able to structure and understand the outside world. Conse­quently, if there is no mental or emotional connection with the mother, the brain’s structuring process is at risk of being destabilized or even regressing. The baby thus experiences a feeling of its own coping disability and incompetence whereupon both are structurally an­chored in its brain instead of a positive sense of capacity and competence. Maternal stress during pregnancy has numerous other negative impacts on the developing brain, for example, it can lead to disorders of the hor­mone production of the hypothalamus, the hypophy­sis, and the adrenal glands—the so-called HPA axis. The constant arousal of the HPA axis eventually leads to an impairment of the immune system as the higher level of cortisol hampers the genes that are responsible for the production of immune transmitters (Balkenhol-Wright & Karrasch, Christine, 2017). During the bonding analysis sessions, the bonding facilitator and the mother-to-be search for the factors or circumstances that may be causing the stress, and then together they work out ways and means to deal with it in order to relieve the pregnant woman’s tension and consequently that of her baby. This also helps to put new impulses into the baby’s brain.

The Impact of Prenatal Influences: A Case History

To ascertain the role of prenatal influences on the unborn child, researchers have for some time been us­ing the experimental technique of cross-fostering to determine how far both prenatal and postnatal environ­mental factors interact with genetic disposition (nature vs. nurture). Hüther (2012) describes one experiment in which they changed the offspring of two rat mothers immediately after birth. One rat mother had proved to be especially competent and caring with a previous litter whereas the other had treated her offspring in a rather negligent and incompetent way. The result was clear: to turn into a caring mother does not necessitate a genetic disposition but very early positive experiences. The researchers then carried out further experiments to verify whether cross-fostering yielded the same re­sults under intrauterine conditions. They transferred female rat embryos almost immediately after fertili­zation, using distinct phyla—the first one appeared to be very cautious when experiencing new surroundings and the second one possessed good spatial orientation skills. Later, after birth and when grown up, the rats be­haved in the same way as the mothers that had born and reared them. The experiment clearly showed that intra­uterine experiences prevail (Hüther, 2012).

The extent to which these findings could be applied to the human species might be demonstrated by the case history of Annette, a 24-year-old German student, who began bonding analysis in the 13th week of her pregnancy (Balkenhol-Wright & Karrasch, 2017). At the time she began the sessions, she did not like or accept the idea of being pregnant. She had had a brief relation­ship with another student who, when learning about the pregnancy, was deeply appalled and furiously de­manded an abortion. So, the first inner picture the fe­tus received was that of utter rejection from both sides, mother and father.

According to Rien Verdult, a Belgian psychotherapist who specializes in the treatment of emotional problems rooted predominantly in life before and immediately af­ter birth, this very early rejection is one of many forma­tive traumas that the unborn baby may suffer at the be­ginning of its intrauterine life (Verdult, 2014)

Annette had also considered having an abortion, but as a Roman Catholic she finally decided against this course of action. However, Annette’s inner deliberations about having an abortion reached the unborn baby and caused a second trauma; and when she told her parents about the pregnancy, her mother in particular reacted quite violently and said that she should give the baby up for adoption immediately after birth. It turned out, during the course of the bonding analy­sis, that Annette’s mother had never liked her daughter; in fact, she had always expressed disappointment at having had a daughter first, and had clearly given pref­erence to Annette’s younger brother. So it seems that rejection ran in the family, and when Annette learnt that she was expecting a baby girl, she felt deep despair and even panic. With the help of the special techniques of the bonding analysis elaborated by Raffai, and in the course of an intense developmental and maturation process, Annette eventually succeeded in accepting her womanhood and hence her motherhood. Raffai’s objec­tive that the pregnant woman should stop being “her mother’s child” in order to become the mother of her own child was achieved (Raffai & Hidas, 2010). Thus An­nette no longer saw her baby as an enemy (a sort of cul­prit that had ruined her life) and by the end of the bond­ing analysis sessions she even perceived her baby girl as an ally. During the inner dialogues, Annette established affectionate contact with her baby: in her mind’s eye she took her baby in her arms, caressed and cuddled it, and most importantly, smiled at it. She conveyed all those images to her baby through the channels previously ex­plained. Moreover, by doing so, she also triggered firing of the mirror neurons in her baby's brain!

Through her mother’s mirroring the prenate internal­izes and assimilates the image that reflects her mother’s perception of her, allowing her to build a positive rep­resentation of her own self. This kind of emotional at­tention also has a positive influence on the formation of neuronal connections and synaptic circuitry. Accepting the baby—especially when accompanied by affection­ate feelings—is a very strong bonding experience that forms the neurological basis of the baby’s capacity to enter into emotionally solid relationships later in adult life (Balkenhol-Wright & Karrasch, 2017).

Translating Annette’s transformation into neurobio­logical terms, the transformational processes that took place in Annette’s baby’s brain can be described as fol­lows. First, the baby’s brain was flooded with negative inner images of rejection, but as Gerald Hüther so ex­pertly explains, the brain’s plasticity always allows for change, so that new positive images can be superim­posed. Before the integration of any new image can oc­cur, however, the corresponding brain regions develop a state of excitement that spreads into the lower subcorti­cal centers, and these function to alter the excitability of the higher cortical neurons via the release of neuro­transmitters. This process generates a state of focused attention that allows the brain to integrate a new image into the brain’s repertoire of inner images by superpos­ing it on a former negative image. As more positive in­ner images reach the brain, the more stable and consoli­dated the neuronal pathways become (Strüber, 2016).

Over time, the structural pattern of neurons and den­drites forms a matrix with which all subsequent neurons and dendrites align. For Annette’s baby this meant that the moment Annette started to convey positive images of herself as a caring and affectionate mother the for­mer negative images of rejection faded away. Of course, it cannot be precluded that vestiges of these negative images will remain or that they may be triggered when a situation arises similar to the negative one that was first experienced. However, as the bonding process be­tween baby and mother continues to build, it enables the baby to form long-lasting coping strategies for deal­ing with stressful situations on the basis of the earlier experienced acceptance, support, empathy, affection, and understanding (Hüther, 2008).

Today, Annette describes her 18-month-old daugh­ter as a lively, easy-going, affectionate little girl who is very creative, eager to discover her surroundings, and appears quite self-contained. This case history, as well as the many other babies whose mothers have been ac­companied by the bonding analysis, is the living proof that this method is an excellent tool that can help pre­vent the later onset of affective disorders such as anxi­ety or depression, amongst others.

Further Prenatal Traumas

There are two other instances of prenatal trauma that are worth mentioning, the first clearly being the birth process itself which every human being inevitably has to go through, and the second is an experience that can cause lifelong sadness and depression and concerns the loss of one or more siblings especially at the begin­ning of the intrauterine life.

Peter Bourquin, a specialist in family constellations, reports on the research of biologist and geneticist, Charles Boklage (see Bourquin & Cortés, 2016). Boklage shows that 12% of all fertilized eggs produce multiple pregnancies; of these, 76% dissolve completely, 22% end up in a single pregnancy, and about 2% lead to the birth of twins. This means that for every twin birth there are at least 10 babies that started their intrauterine life as a twin but were born as a singleton, having lost a brother or sister early in their intrauterine life (Bourquin & Cortés, 2016).

The most tragic part of that experience is that the withering away of one of the twins often happens dur­ing the first trimester of the pregnancy—that is to say at a time when the disappearance of one fetus goes mostly unnoticed by the pregnant woman. No-one else but the remaining baby suffers that loss, and that means losing the most important person in its life, a person that is even more important than the mother as scientists spe­cializing in twin research have found.

Every psychotherapist who has a long experience of treating adult patients suffering from depression of var­ious degrees of intensity caused by the loss of a beloved person knows how devastating this loss can be. It does not take a lot of imagination to conceive the impact of such a loss on the prenate. Extremely strong feelings are being triggered, on one side feelings of utter loneliness, abandonment, yearning and mourning, but on the oth­er side also, feelings of guilt (Did I kill him/her? or Why couldn’t I save him/her?), fury (Why was I left behind?), and even the terror of dying too. All these strong feel­ings have a deep, formative impact on the neurogenesis of the limbic system that may lead to a state of shock-induced paralysis.

In his book, Raffai describes how pregnant women gained that kind of experience, actually receiving the image of their unborn baby crouched in the womb, of­ten motionless, not able to react to the mother’s trying to get into mental contact. In a number of cases the loss of a twin was represented in the womb by a black spot and the surviving baby avoided moving to that place (Raffai, 2015).

Obviously no research is possible on a prenate’s brain’s reaction to the loss of a twin, but by extrapolat­ing the results of research carried out on the adult brain it can be assumed that identical processes take place in the unborn baby’s brain, even with greater intensity, as the baby has not yet developed appropriate resilience and cognitive, emotional, and behavioral coping strate­gies to handle such a traumatic experience.

Research on adults’ mourning has shown that the longer the mourning period goes on, eventually turn­ing into a deep depression, the neurogenesis of the hip­pocampus comes to a standstill, and massive disorders arise in the same neuronal circuitry that also reacts to stress, the most important being the HPA axis. The hy­pothalamus produces too much corticotropin releasing factor (CRF), which in turn causes the pituitary gland to release adrenocorticotropic hormone (ACTH), which again stimulates the adrenal cortex to produce the stress hormone cortisol. So the same operating pro­cesses are going on in the prenate’s brain, whether due to maternal stress or the loss of a twin brother or sister (Roth & Strüber, 2015).

If in the course of the bonding analysis sessions the bonding facilitator has indications that the pregnancy may have started as a twin or even as a multiple, the pregnant woman is invited to mentally visualize her uterus and to see whether she finds traces of a twin loss (often taking on the form of a dark spot as Raffai found in a number of cases). In this instance, Raffai’s corresponding instructions are clear and quite simple. The mother-to-be is to explain to her baby that she has become aware of the loss and then she invites her baby to mourn with her. In many cases the baby reacts positively and Raffai actually experienced that babies had woken from their stupor-like state. The baby then gains the experience that its feelings of sorrow are per­ceived and mirrored. This process, made possible due to the brain’s plasticity, contributes to building resilience and strengthens the acquisition of the coping capacities mentioned above (Raffai & Hidas, 2010). With regard to the trauma of twin loss, the use of assisted reproductive technology may produce a large number of traumatized babies caused firstly by the con­ception that takes place in the totally sterile surround­ings of a laboratory and then eventually by what is known as embryo selection. In these cases also, bonding analysis can similarly be used as a beneficial technique to offset the sequelae of these kinds of traumatic experi­ence.

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